The mission of CalAIM (California Advancing and​ Innovating Medi-Cal) is to improve the continuum of care across Medi-Cal, ensuring patients are appropriately managed through a comprehensive array of health and social services at all stages of life, from birth to end of life. To meet the health needs of members in an integrated, patient-centered, whole-person fashion, the Department of Health Care Services (DHCS) is integrating delivery systems and aligning funding, data reporting, quality, and infrastructure to mobilize and incentivize towards common goals.

CalAIM proposals offer solutions to ensure the stability of Medi-Cal programs and allow the critical successes of waiver demonstrations such as Whole Person Care, the Coordinated Care Initiative, public hospital system delivery transformation, and the coordination and delivery of quality care to continue and be expanded to all Medi-Cal enrollees.

This resource guide summarizes CalAIM initiatives that will impact Behavioral Health and Human Service providers in California. It is intended to help your organization understand and thrive under the new Medi-Cal and CalAIM requirements. 

In this guide you will find:

• Background & Overview – What is CalAIM?
• Core CalAIM Concepts
• Overview of Initiatives That Impact Behavioral Health and Human Service Providers
• Details on CalAIM Behavioral Health Initiatives
  • Behavioral Health Delivery System Transformation
  • Behavioral Health Payment Reform
  • Medical Necessity Criteria
  • Behavioral Health Documentation Redesign
  • Standardized Screening & Transition of Care Tools
  • “No Wrong Door” & Co-Occurring Treatment
  • Drug Medi-Cal Organized Delivery System (DMC-ODS) Policy Improvements
  • Drug Medi-Cal ASAM Level of Care Determination
  • Administrative Integration of Specialty Mental Health and Substance Use Disorder Services
  • Mobile Crisis Services
• Information on Funding Initiatives and Incentive Programs

This guide was specifically designed for County Behavioral Health and Human Service Departments, or Mental Health Plans (MHP). If you are a provider, community-based organization (CBO), or county contractor please download our Provider Edition of the CalAIM Guide.

If you’d like to learn how Qulifacts is helping agencies adhere to the objectives and challenges of the CalAIM initiative and emerging Value Based Reimbursement (VBR) payment models please email us today at BDRteam@qualifacts.com

Given the significant changes coming, there is no safer partner to assist agencies through the forthcoming transition than Qualifacts. Our EHR platforms help California behavioral health and human services providers achieve greater performance, take the burden out of compliance, and deliver outstanding care to those in need. From meeting Medi-Cal and upcoming CalAIM requirements to optimizing clinical workflows and demonstrating positive outcomes.